Cheryl’s Story: CAR T Patient and Pioneer

In the almost two years since Cheryl Wiers was diagnosed with cancer, the Redlands, California, mother of two young children has given a lot of thought to the question of why.

“Something as big as cancer doesn’t happen for no reason,” she reflected. “I think there is a greater purpose for it.”

Wiers believes one purpose is her participation in a clinical trial using what is arguably the most promising cancer treatment — chimeric antigen receptor (CAR) T cell therapy. Such therapies reprogram one type of the body’s immune cells — T cells, which are white blood cells — to recognize and destroy cancer cells by adding a CAR to those cells.

In Wiers’s case, CAR T cells were genetically engineered to target the antigen CD19, a protein found on the surface of non-Hodgkin lymphoma (NHL) and other cancer cells.

An Immunotheraphy Breakthrough

Starting in the late 1990s, in an effort led by Stephen Forman, M.D., and Michael Jensen, M.D., City of Hope was one of the first cancer hospitals in the nation to use CAR T therapies in preclinical trials for blood cancers. Wiers is one of 180 patients who have taken part in CAR T cell therapy trials at City of Hope. In Wiers’s case, she was part of a trial in which patients received CAR T cell therapy to help build an immune response against cancer cells.

So far, the treatment combining stem cell transplant with CAR T therapy has worked for Wiers and other patients, and it is hoped that this will help preserve the remission and improve the results of transplant, and possibly become a way of improving the cure rate for both transplant and CAR T cell therapy. The approach has kept Wiers’s cancer — NHL of the breast — from returning a third time.

I’m extremely grateful for the treatment I’ve received at City of Hope, and it’s exciting feeling like you are going through this to help other people,” said Wiers, 43, the mother of a 6-year-old boy and an 8-year-old girl.

A Frightening Diagnosis

Wiers, a speech therapist, was first diagnosed with NHL in January 2016.

“I felt a lump in my breast but assumed it was a cyst because I had already had one removed before,” she said. “I didn’t have any other symptoms — that was the only thing I could feel.”

Wiers recalls her primary care doctor called her at work to tell her the lump was cancerous. For the rest of the work day, she found it difficult to concentrate, the diagnosis clouding her thoughts.

Primary NHL of the breast is a rare type of cancer that occurs in a breast’s lymph nodes and can initially be mistaken for breast cancer. Chemotherapy, radiation and stem cell transplants are standard treatments that are used to combat lymphoma, but CAR T therapy is also emerging as a promising option.

Wiers received chemotherapy at a local hospital when she first learned she had lymphoma. She received six rounds of chemotherapy, which prevented the cancer from spreading to her brain.

At times, I was really nervous about it returning, but I just tried to stay positive,” she said. “It helps that we are surrounded by a group of wonderful family and friends who have rallied around us.”

Another Option

A relative of her husband, Matt, had already told her that she should get a second opinion from Forman, the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation, leader of City of Hope’s Hematologic Malignancies and Stem Cell Transplantation Institute and an internationally-renowned expert in the treatment of blood cancers. Forman also leads City of Hope’s CAR T cell research, including its clinical trials, and was one of the first doctors in the nation to oversee the therapy in lymphoma patients.

Wiers knew that because her lymphoma had relapsed, she would need a stem cell transplant. And once she met Forman, also a pioneer in the field of bone marrow stem cell transplantation, she knew he had found the right doctor to guide her treatment.

Forman recommended the transplant and Wiers’s participation in the phase 1 clinical trial for NHL and some leukemia patients who had already received chemotherapy; the CAR T therapy would be an additional boost against the lymphoma.

Wiers’s T cells were collected almost two weeks prior to the stem cells for her transplant. Her T cells were isolated from a sample of her blood, then genetically engineered to target her cancer.

Wiers then received high-dose chemotherapy to kill off cancer cells, a routine treatment for transplant patients, that also prepared her body to receive new, healthy cells. A few days later, she received her own stem cells to produce new, healthy blood cells. Two days after that, the CAR T cells were then infused back into Wiers’s blood stream and redirected to attack cancer cells.

New Normal

Family and friends pitched in to help care for Wiers’s kids, including her mother and mother-in-law, who traveled from out-of-state.

Throughout her treatments, Wiers and her husband, have made an effort to keep the children’s routine as normal as possible. That means keeping them in school and participating in activities such as soccer, play dates and their friends’ birthday parties.

“The kids have dealt with everything remarkably well,” Wiers said. “My son, who was 4 when this started, recently told me: ‘I don’t even know what you look like with long hair.’”

Wiers’s lymphoma hasn’t returned, and she’s hopeful about the future.

“I’m ready to go back to work and to a new normal,” she said. “I want to put all this behind me.”